Jennifer Katz Inc. welcomed Melissa Wilson-Beer, AuD from Sound Speech and Hearing Clinic to speak to our team at our spring 2019 summit. Melissa gave us tons of helpful information about Central Auditory Processing Disorders (CAPD). We also attended American Speech-Language Hearing Association’s (ASHA) 2019 online CAPD conference in April and walked away some big takeaways for speech and language pathologists.

WHAT ARE THE SIGNS OF CAPD?
-Sound sensitivity (especially when very young)
-Easily distracted/difficulty hearing when background sounds/noise are present
-Difficulty localizing the source of a signal
-Difficulty hearing on the phone
-Often says “what?” or “huh?”
-Frequently requests repetition
-Difficulty following multi-step directions
-Difficulty following rapid speech
-Academic problems – reading, spelling, and writing
-Difficulty learning a foreign language
-Slow processing of thoughts
-Interpreting words too literally, missing out on puns, jokes, and figurative language
-Poor singing, musical ability, and/or appreciation of music

DIFFERENTIAL DIAGNOSIS OF ADHD VS. CAPD
RANK ORDER ADHD:
Inattentive
Distracted
Hyperactive
Fidgety/restless
Hasty/impulsive
Interrupts/intrudes

RANK ORDER CAPD:
Difficulty hearing in background noise
Difficulty following oral directions
Poor listening skills
Academic difficulties
Poor auditory associations
Distracted
Inattentive

THE ROLE OF THE SLP
-Identifying the cognitive-communicative and/or speech and language factors that may be associated with CAPD
-Helping to identify or differentiate disorders in phonology or language processing that may be comorbid to CAPD
-Helping to determine the precise nature of the diagnosed disorder(s) and the functional implications associated with the disorder(s)
-Communicating results and recommendations to the patient/family and other appropriate parties
-Referring the patient to other professionals, as needed, to facilitate access to comprehensive services (e.g., audiology, psychology, and neuropsychology)

SLP SCREENING FOR CAPD
Normed Tests:
SCAN-C, SCAN-A, SCAN-3
The Listening Inventory
Auditory Continuous Performance Test
Auditory Skills Assessment
Differential Screening Test for Processing

Checklists:
Children’s Auditory Performance Scale (CHAPS)
Children’s Home Inventory for Listening
Difficulties (CHILD)
Screening Instrument for Targeting Educational Risk (SIFTER)
Listening Inventory for Education (LIFE)
Fisher’s Auditory Problems Checklist

SLP & AuD OVERLAP
Audiologist: Auditory Processing
Overlap: Acoustic/Phonemic Processing
SLP: Language Processing

Acoustic Processing: Modifications & Strategies
-Gain visual attention before presenting verbal directions
-Position yourself in good light and facing student
-Eliminate/reduce distracting background noise
-Direct signal enhancement via assistive tech
-Use clear speech
*Improving access to acoustic signal

Phonemic Processing: Modification & Strategies
-Use visual phonics or gestures to represent various auditory sounds
-Play games using visual-motor actions to represent auditory sounds or segments
-Play detective to analyze and segment sound aspects of words
-It’s about structure and quantity of incoming information

GOALS OF MULTIDISCIPLINARY APPROACH
-Strengthen auditory & listening skills & strategies
-Provide compensatory methods to minimize functional listening deficits
-Promote efficient allocation of perceptual and higher-order (central) resources (e.g., language, memory, attention, executive control)

TREATMENT PERSPECTIVES
Central auditory processing depends on many systems and processes, so comprehensive, bottom-up, and top-top intervention approaches are needed to maximize effectiveness. (Chermak 2018)

“The central auditory skills represent a foundational set of skills that interact with other sensory-communicative-cognitive skills and contribute to our success in using higher order skill areas. Any breakdown in these foundation skills puts the listener at risk for deficits in academics, communication, and psychological well-being.” (Ferre 2018)

TREATMENT: Auditory Based
-FM system
-Speaker System
-Noise Cancelling Headphones
-Livescribe Smartpen
-Classroom Accommodations
-Tennis Ball Cutter (tennisballcutter.com)
-Sound Level Meter apps
-Raindrop.IO (raindrop.io/collection/

TREATMENT: Visual Based
-Speech-to-Text
-Text-to-Speech

TREATMENT: Computerized Programs
-Zoo Caper Skyscraper
-CAPDOTS
-LiSN & Learn
-Fast ForWord

WHY TOP-DOWN TRAINING?
“Our central auditory skills do not and cannot exist in a vacuum. Without development of higher-level phonologic-linguistic and executive skills, those acoustic cues are meaningless.” -Ferre

COMPENSATORY STRATEGIES
Metalinguistic Strategies:
-schema induction (i.e., predicting elements in a message) and discourse cohesion devices (i.e., grammatical means to link and establish relationships between sentences and paragraphs)
-use of graphic organizers (e.g., problem–solution map; story map; semantic network tree)
-use of context to understand and build vocabulary
-phonological awareness
-semantic network expansion
-active listening

Metacognitive Strategies:
-self-instruction
-organization skills
-metamemory techniques (e.g., mnemonics, mind mapping)
-problem solving
-assertiveness training

SLP TREATMENT PROGRAMS
-Virtual Speech Center Apps -(www.virtualspeechcenter.com/): Auditory Workout, Auditory Processing Studio, Word Retrieval, School of Multi-Step Directions
-Acoustic Pioneer – Feather Squadron (acousticpioneer.com/auditorytraininggames.html): Screening tool, dichotic training, tonalpattern training; Available online and in apps
-Brain HQ (www.brainhq.com/): Attention, brain speed, memory, people skills, navigation, intelligence
-Lauren Enders, SLP, Pinterest Page (www.pinterest.com/lasenders/): Lots of practical information, products,
-HearBuilder from Super Duper: Following Directions, Phonological Awareness, Auditory Memory, Sequencing
-SmartyEars Apps (www.smartyearsapps.com/): Auditory memory, AAC, categories, sequencing, language
-Hamaguchi Apps (www.hamaguchiapps.com/): Speech, language, auditory development
-Apps for Literacy (bit.ly/Apps4Literacy)
-Auditory Figure Ground
-Auditory Workout
-Feather Squadronapps

WEBSITE RESOURCES:
www.friendshipcircle.org/blog/2012/03/21/8-headphones-for-children-with-autism-andauditory-processing-disorder/
www.amazon.com/Reduction-Headphone-Auditory-Processing-Sensitivity/dp/B01MPZMKV2
www.enablemart.com/sensory/auditoryprocessing
www.rule-the-school.com
www.successforkidswithhearingloss.com
www.idainstitute.com
www.neurotone.com/lace-interactive-listeningprogram
www.clearworks4ears.com
www.asha.org/uploadedFiles/Resource-for-DoJ-10-2014.pdf
www.asha.org/public/hearing/Auditory-Processing-Disorder
www.asha.org/policy/TR2005-00043/
www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children

REFERENCES:
American Speech-Language-Hearing Association (2019). Scope of practice in speech-language pathology [Practice Portal]. Available from www.asha.org/practice-portal/.
Chermak, G.D. (2018). CAPD: Evidence-Based Practice Recommendations [PowerPoint slides].
ASHA Online Conference Central Auditory Processing Disorders (2018).
Childress, T. (2018). Assistive Technology For Students With (C)APD [PowerPoint slides]. ASHA Online Conference Central Auditory Processing Disorders (2018).
Ferre, J.M. (2018) Screening Students for CAPDs [PowerPoint slides]. ASHA Online Conference
Central Auditory Processing Disorders (2018).
Rawool, V.W. (2018) Computerized Auditory Training for Improving Auditory Processing Skills
[PowerPoint slides]. ASHA Online Conference Central Auditory Processing Disorders (2018).
Richard, G.J (2018). How to “process’ auditory processing disorders [PowerPoint slides]. ASHA
Online Conference Central Auditory Processing Disorders (2018).